颅脑创伤外科手术指南脑实质损伤

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(3) 对于单纯脑内血肿、无明显脑挫
裂伤、CT出现明显占位效应的病 人，按照血肿部位，采用相应部位 较大骨瓣开颅清除血肿、彻底止血 ，根据术中颅内压情况决定保留或 去骨瓣减压，硬膜原位缝合或减张 缝合
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• Patients with parenchymal mass lesions who do not show evidence for neurological compromise, have controlled intracranial pressure (ICP), and no significant signs of mass effect on CT scan may be managed nonoperatively with intensive monitoring and serial imaging.
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急性脑内血肿和脑挫裂伤
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1．手术指证：
(1) 对于急性脑实质损伤(脑内血肿、
脑挫裂伤)的病人，如果出现进行 性意识障碍和神经功能损害，药物 无法控制高颅压，CT出现明显占 位效应，应该立刻行外科手术治疗
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(2) 额颞顶叶挫裂伤体积>20ml，中
线移位>5mm，伴基底池受压，应 该立刻行外科手术治疗
KEY WORDS:
Coma, Computed tomographic parameters, Craniotomy, Decompressive craniectomy, Head injury, Herniation, Intracranial pressure monitoring, Parenchymal mass lesion, Surgical technique, Timing of surgery, Traumatic brain injury
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• Bifrontal decompressive craniectomy within 48 hours of injury is a treatment option for patients with diffuse, medically refractory posttraumatic cerebral edema and resultant intracranial hypertension.
Guidelines for the Surgical Management of Traumatic Brain Injury
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SURGICAL MANAGEMENT OF TRAUMATIC PARENCHYMAL LESIONS
RECOMMENDATIONS (see Methodology)
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• Decompressive procedures, including subtemporal decompression, temporal lobectomy, and hemispheric decompressive craniectomy, are treatment options for patients with refractory intracranial hypertension and diffuse parenchymal injury with clinical and radiographic evidence for impending transtentorial herniation.
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Indications for Surgery
• Patients with parenchymal mass lesions and signs of progressive neurological deterioration referable to the lesion, medically refractory intracranial hypertension,or signs of mass effect on computed tomographic (CT) scan should be treated operatively.
源自文库12
(3) 急性脑实质损伤病人，通过脱水
等药物治疗后颅内压≥25mmHg， 脑灌注压≤65mmHg，应该行外科 手术治疗
(4) 急性脑实质损伤(脑内血肿、脑挫
裂伤)病人无意识改变和神经损害 表现，药物能有效控制高颅压， CT未显示明显占位效应，可在严 密观察意识和瞳孔等病情变化下， 继续药物保守治疗 。
Timing and Methods
• Craniotomy with evacuation of mass lesion is recommended for those patients with focal lesions and the surgical indications listed above, under Indications.
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• Patients with Glasgow Coma Scale (GCS) scores of 6 to 8 with frontal or temporal contusions greater than 20 cm3 in volume with midline shift of at least 5 mm and/or cisternal compression on CT scan, and patients with any lesion greater than 50 cm3 in volume should be treated operatively.
2．手术方法：
(1) 对于额颞顶广泛脑挫裂伤合并脑
内血肿、CT出现明显占位效应病 人，应该提倡采用标准外伤大骨瓣 开颅清除脑内血肿和失活脑挫裂伤 组织、彻底止血，常规行去骨瓣减 压，硬膜减张缝合
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(2) 对于无脑内血肿、额颞顶广泛脑
挫裂伤脑肿胀合并难以控制高颅压、 出现小脑幕切迹疝征象的病人，应 常规行标准外伤大骨瓣开颅，硬膜 减张缝合，去骨瓣减压